Healthy Marriage and Relationship Education for Expectant and New Mothers: The One-Year Impacts of MotherWise

Publication Date: September 29, 2021
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  • Published: 2021


Research Questions

  1. What are the one-year impacts of MotherWise, an HMRE program for expectant and new mothers, on women’s relationship skills, attitudes, and outcomes?

Many healthy marriage and relationship education (HMRE) programs funded by the federal government serve individual adults rather than couples. Such programs aim to help participants form and maintain healthy romantic relationships and avoid unhealthy relationships, regardless of their relationship status. These programs serve a mix of populations and often cover such topics as how to choose a partner wisely, how to improve communication skills, how relationship choices may affect many aspects of life, and how to recognize unhealthy relationships and leave those relationships safely.

Although the prevalence of HMRE programs serving individual adults has grown over recent years, there is little rigorous evidence of their effectiveness. To date, large-scale evaluations of HMRE programs have focused mostly on programs for adult couples. The few existing studies of HMRE programs for individual adults either use quasi-experimental methods, examine short-term effects, or examine programs that serve populations or operate in settings that are dissimilar to those of federally funded HMRE programs.

To help build the evidence base on the diverse set of HMRE programs serving individual adults, this study examines MotherWise, a relationship skills program for women with low incomes who are pregnant or have just had a baby. In 2015, the University of Denver received a five-year grant from the  Office of Family Assistance within the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services to deliver the program, which aims to empower women to make informed decisions about relationships and other life choices. The program included a core group workshop made up of six weekly four-hour sessions, individual case management, and an optional couples’ workshop.


This report is the second in a series on the implementation and impacts of MotherWise. It describes the program’s impacts after one year. These impacts were estimated by comparing the outcomes of women who were randomly assigned to either a group that was offered MotherWise services or a control group that was not. The report also provides information on program implementation and costs and documents the study methods. An earlier report provided detailed information on the program’s design and implementation during the first year of the impact study. A future report will examine longer-term impacts of the MotherWise program, based on a follow-up survey of women 30 months after they enrolled in the study. Mathematica and Public Strategies conducted this study as part of the Strengthening Relationship Education and Marriage Services (STREAMS) evaluation for ACF.

Key Findings and Highlights

  • MotherWise positively affected women’s relationship skills and attitudes after one year. Compared to women in the control group, those offered the MotherWise program reported better relationship skills and more healthy attitudes toward relationships one year after entering the program.
  • Women in the MotherWise group were less likely to report having an unintended pregnancy in the year after entering the study. Only 7 percent reported an unintended pregnancy during this period, compared to 11 percent of women in the control group.
  • Women in the MotherWise and control groups reported similar levels of experiences with intimate partner violence, co-parenting quality, and emotional well-being at the one-year follow-up.
  • About three-quarters of women entered the MotherWise study in a steady romantic relationship with their baby’s father. In both the program and control groups, about 9 in 10 of these women remained in that relationship a year later. Exploratory analyses suggest that, among women who remained in a relationship with their baby’s father, MotherWise improved the quality of that relationship.


Between September 2016 through December 2018, 949 women enrolled in the study. To be eligible for the study, women had to be at least 18 years old and either be pregnant or have delivered a baby in the previous three months. The study team randomly assigned women to either (1) a group that was offered the MotherWise program or (2) a control group that was not offered the program but was free to seek other services available in the community. For the impact analysis presented in this report, we used data from a baseline survey that was administered at the time of enrollment and a one-year follow-up survey. A total of 799 women responded to the one-year follow-up survey, for a response rate of 84 percent. Response rates were similar between the program and control groups.


MotherWise took a unique approach to offering HMRE services to individual adults. It served exclusively expectant and new mothers with low incomes and aimed to empower them to make healthy decisions about their relationships that would keep them and their children safe. The positive impacts on women’s relationship skills and attitudes provide some promising evidence of the potential of this approach.

The findings of this study offer an interim look at the program’s effects one year after women entered the program. Some results are encouraging. The program reduced the number of unintended pregnancies during the one-year follow-up period, which suggests that MotherWise may have encouraged women to make more deliberate decisions about family planning. Although we found no impacts on intimate partner violence and co-parenting at the one-year follow-up, we found impacts on related outcomes such as perceived conflict management skills and attitudes concerning intimate partner violence. Because relationship outcomes can take time to unfold, impacts on co-parenting and experiences of intimate partner violence may still emerge at a later point. The 30-month impact study will provide evidence on the longer-term effects of MotherWise on relationship outcomes, as well as the overall well-being of participants and their children.

Why did MotherWise succeed in improving relationship skills and attitudes and reducing unintended pregnancies? One factor may have been the program’s strong implementation. Participants regularly attended and engaged with program services; nearly two-thirds of participants completed the workshop. Moreover, the program leadership (which included developers of the Within my Reach curriculum) was  closely involved with program implementation, helping to ensure that the program was implemented with fidelity. These findings underscore the importance of strong implementation for program success. Another factor may have been the well-defined population that the program served—women with low incomes who were expecting or had just had a baby. Having a well-defined service population allowed the program to tailor services more closely to their participants’ specific needs, which may have contributed to its effectiveness. Other HMRE programs serving individual adults may want to consider focusing their service populations on adults in particular family or relationship situations to allow them to tailor program services more closely to participant needs. Finally, the birth of a child may be a time when women are particularly open to taking stock of their romantic relationships, potentially making them more receptive to the program’s healthy relationship content. Therefore, women with low incomes who are expecting a baby or have just had one may be particularly well suited for HMRE services and thus be a group future HMRE programs should consider serving. HMRE programs for individual adults could also consider serving other populations whose life circumstances might prime them to be more receptive to HMRE content. The 30-month findings will provide additional insights into the program’s impacts.   

The findings presented in this report indicate that programs similar to MotherWise can improve certain outcomes of new and expectant mothers with low incomes by offering them HMRE services and other supports. HMRE programs for individual adults can vary in the populations they serve and the services they offer, as well as the outcomes they try to influence. Future studies that examine other such programs can help develop a more complete picture of the potential effects of HMRE programs for individual adults on the full range of populations they serve.


Patnaik, Ankita, and Robert G. Wood (2021). Healthy Marriage and Relationship Education for Expectant and New Mothers: The One-Year Impacts of MotherWise, OPRE Report #2021-183, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.